Schema Therapy with Emotionally Inhibited and Fearful Patients

Emotional inhibition and avoidance are frequent problems in psychotherapy and often block the therapeutic process. Most often patients learnt these behavioral patterns early in childhood as coping strategies to protect themselves from painful emotions such as fear, sadness or shame. Schema therapy (ST) was specifically designed for patients with such rigid and hard to break through behavioral patterns and has shown to be a successful treatment for patients with cluster-C-personality disorders, which extensively display inhibited and fearful behavior. ST provides a set of techniques to address emotional inhibition and avoidance. The schema mode model helps patients to understand the origin and persistence of their problems and therapists can directly apply specific techniques for each mode. The therapist creates a caring, warm, parent-like relationship (‘limited reparenting’) and by this helps the patient to feel safer with emotions and with other people. Simultaneously, the therapist empathically confronts the patient with the problematic consequences of his behavior and pushes for change. Moreover, experiential techniques are frequently applied to help the patient experience and regulate emotions and needs in a safe way. By this, the patient loses fear of emotions, the meaning of emotions is changed and, thus, the patient can reduce using dysfunctional coping mechanisms. In this article, we describe the rational and the specific techniques of ST and illustrate them with a case example.